Adults: 500 mg/m2 as an I.V. infusion over 10 minutes on day 1 of each 21-day cycle. The recommended dose of cisplatin is 75 mg/m2 infused over 2 hours starting approximately 30 minutes after pemetrexed administration ends.

➣ Nonsquamous non-small-cell lung cancer

Adults: 500 mg/m2 I.V. infusion over 10 minutes on day 1 of each 21-day cycle for single-agent use, or in combination with cisplatin infused over 2 hours starting approximately 30 minutes after pemetrexed administration ends

Contraindications

Precautions

Use cautiously in:• hepatic or renal impairment, neurotoxicity• pregnant or breastfeeding patients• children (safety and efficacy not established).

Administration

• Reconstitute 500-mg vial with 20 ml preservative-free normal saline solution injection, yielding 25 mg/ml. Gently swirl vial until powder dissolves completely.• Further dilute appropriate volume of reconstituted solution to 100 ml with preservative-free normal saline solution injection; administer I.V. over 10 minutes.• Know that drug is physically incompatible with diluents containing calcium, including Ringer's and lactated Ringer's solutions. Administration with other drugs and diluents isn't recommended.• Administer I.V. only.• As ordered, pretreat with dexamethasone (or equivalent) 4 mg P.O. twice daily on day before, day of, and day after pemetrexed administration to minimize cutaneous reactions.• When administering with cisplatin, hydrate patient with 1 to 2 L fluid infused over 8 to 12 hours before and after cisplatin administration. Maintain adequate hydration and urine output for 24 hours.• To reduce toxicity, ensure that patient receives at least five daily doses of low-dose folic acid or multivitamin with folic acid within 7 days before first pemetrexed dose. Folic acid therapy should continue throughout course of therapy and for 21 days after final dose. Patient also must receive one I.M. injection of vitamin B12 during week before first pemetrexed dose and every three cycles thereafter.• Discontinue drug if creatinine clearance is below 45 ml/minute or patient has hematologic or nonhematologic Grade 3 or 4 toxicity after two dosage reductions (except Grade 3 transaminase elevation).• Withdraw drug immediately in patients with Grade 3 or 4 neurotoxicity.

Patient monitoring

• Monitor CBC and platelet counts frequently.• Monitor renal and liver function tests and blood chemistry results (especially serum creatinine) periodically.• Know that patients with mild to moderate renal insufficiency should avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) with short elimination half-lives (such as aspirin, diclofenac, and ibuprofen) for 5 days before, on day of, and for 2 days after pemetrexed administration. If concomitant NSAID use is necessary, monitor patient closely for toxicities (especially myelosuppression and renal and GI toxicity).• Be aware that all patients should avoid NSAIDs with long half-lives (such as diflunisal, piroxicam, and sulindac) for at least 5 days before, on day of, and for 2 days after pemetrexed administration. If concomitant NSAID use is necessary, monitor patient closely for toxicities (especially myelosuppression and renal and GI toxicity).

Patient teaching

• Instruct patient to take folic acid and vitamin B12 before and during therapy, as prescribed.• Advise patient to drink ten 8-oz glasses of fluid and to urinate frequently during first 24 hours after therapy that includes cisplatin.• Teach patient to recognize signs and symptoms of anemia and to contact prescriber if temperature above 100.4 °F (38 °C) develops.• Tell patient to consult prescriber before taking products containing ibuprofen.• Advise female with childbearing potential to avoid pregnancy during therapy.• Instruct breastfeeding patient to stop breastfeeding during therapy.• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

PEMEtrexed

(pe-me-trex-ed) ,

Alimta

(trade name)

Classification

Therapeutic: antineoplastics Pharmacologic: antimetabolites

Pregnancy Category: D

Indications

Malignant pleural mesothelioma (with cisplatin) when tumor is unresectable or patient is not a candidate for surgery.Local advanced or metastatic nonsquamous non–small cell lung cancer as initial therapy (with cisplatin), in previously treated patients (as monotherapy), or as maintenance treatment in patients whose disease has not progressed after 4 cycles of platinum-based chemotherapy.

Gastrointestinal

Dermatologic

Hematologic

anemia

hemolytic anemia

leukopenia

thrombocytopenia

Neurologic

neuropathy

Miscellaneous

fever (most frequent)

infection (most frequent)

Interactions

Drug-Drug interaction

NSAIDs, especially those with short half-lives, ↑ blood levels and risk of toxicity; avoid for 2 days before, day of, and 2 days after treatment. Probenecid ↑ blood levels.Concurrent use of nephrotoxic agents ↑ risk of nephrotoxicity.

Lab Test Considerations: Monitor CBC and platelet counts for nadir and recovery and renal function, before each dose and on days 8 and 15 of each cycle and chemistry for renal and liver functions periodically. May cause neutropenia, thrombocytopenia, leukopenia, and anemia. A new cycle should not be started unless the ANC is at least 1500 cells/mm3, platelet count is at least 100,000 cells/mm3, and creatinine clearance is at least 45 mL/min. If nadir of ANC is less than 500/mm3 and nadir of platelets are at least 50,000/mm3 decrease doses of pemetrexed and cisplatin by 75%. If nadir of platelets is less than 50,000/mm3 regardless of ANC nadir decrease pemetrexed and cisplatin doses by 50%.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)

Implementation

Do not confuse pemetrexed with pralatrexate.

Pemetrexed should be administered under supervision of a physician experienced in the use of chemotherapeutic agents.

To reduce toxicity, 0.4–1 mg of folic acid must be taken daily for 7 days preceding first dose of pemetrexed and should continue during and for 21 days after last dose. Patients must also receive an injection of vitamin B12 1 mg IM during the week preceding first dose of pemetrexed and every 3 cycles thereafter. Subsequent doses of vitamin B12 may be given on same day as pemetrexed. Also administer dexamethasone 4 mg twice daily the day before, the day of, and the day after pemetrexed administration.

Intravenous Administration

Intermittent Infusion: Calculate number of pemetrexed 500-mg vials needed; vials contain excess to facilitate delivery. Reconstitute 500 mg with 20 mL of preservative–free 0.9% NaCl. Concentration: 25 mg/mL. Swirl gently until powder is completely dissolved. Solution is clear and colorless to yellow or green-yellow. Do not administer if discolored or containing particulate matterDiluent: Dilute further to 100 mL with preservative–free 0.9% NaCl. Solution is stable at room temperature or if refrigerated for up to 24 hr.

Instruct patients to notify health care professional if persistent vomiting, diarrhea, or signs of dehydration appear.

Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and to avoid alcohol during therapy.

Advise patient to avoid becoming pregnant during therapy. If pregnancy is planned or suspected, notify health care professional promptly.

Evaluation/Desired Outcomes

Alimta

Alimta

Patient discussion about Alimta

Q. After Taxol/Carbo, then Alimta, treatments stopped because tumors no longer shrinking. Anything else to try? I was diagnosed with Stage 3 lung cancer about 6 months ago. Because of the weakness
of my lungs due to advanced COPD, the Oncologist ruled out surgery & radiation so
Chemo was the only alternative. I am now under Hospice care.

A. this is a question that the oncologist should answer...there are a lot of chemo treatments out there- but not always firring to the type of lung caner. but i'm sure he would suggest them...look- there's some treatments in clinical trials. check them out maybe there'll be something for you. look under the topic "research":http://www.nlm.nih.gov/medlineplus/lungcancer.html#cat27

TRC102 is a small molecule inhibitor of DNA base excision repair that shows very promising results in animal models and cancer patients when administered in conjunction with chemotherapeutic agents such as Temodar and Alimta," said Jeffrey Bernard, Formatech's director of business development.

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